Sleeping or Dead?

I walk into a patient's room, and he's sitting in the chair, slumped over, while his wife reads a magazine.

"He's just sleeping, right?"

"Oh, I don't know -- you're the doctor."


Probably not the best question for me to ask.  But, also, if you don't know if your loved one is sleeping or dead, perhaps you should check that instead of continuing to read a magazine.  In case you need some help telling the difference:

Is he moving?  Yes?  Sleeping.  No?  Maybe sleeping.

Does he respond when you call his name?  Yes?  Not dead.  No?  Could go either way.

Is he breathing?  Yes?  Sleeping.  No?  Dead.

Is his body cold to the touch?  No?  Probably sleeping.  Yes?  Probably dead.

Are his limbs stiff?  No?  Probably sleeping.  Yes?  Probably dead.

Does he smell funny?  No?  Probably sleeping.  Yes?  Could be either.

Has someone already declared him dead?  No?  Might be sleeping.  Yes?  Almost certainly dead.

Is there a coroner in the room?  Yes?  Probably dead.

Is someone asking him to fill out tomorrow's dinner menu?  Yes?  Could be either sleeping or dead.

"Is Someone Hurting You?"

"I'm noticing you have a bunch of bruises," I say to my fairly robust 92-year-old patient.  "I have to ask... has someone been hurting you?"

"Well...."

"You can tell me if something's going on, and we can try to help."

"Well...."

"Seriously, is someone hurting you?"

"When I was eight, there was this neighbor...."

"Um, we can talk about that if you want, but I actually meant more recently.  To cause these bruises...?"

"Oh, someone hurting me now?"

"Yeah."

"No, no one's hurting me.  I just fall a lot."

"You sure?  No one's getting frustrated and hitting you?"

"No!  I would hit back!"

"Okay, I just wanted to make sure."

"So you don't need to know what happened when I was eight?"

"Not unless you need to talk about it, in which case we can, or I can refer you to someone who you can talk to...."

"No, I'm okay."

"Okay, great.  Now let's talk about your medication list...."

Tell My Son. No, My Other Son. No, My Other Son.

"So, unfortunately the test results were as we expected, and you're going to need to see a specialist and figure out the best treatment."

"Would you mind giving my son a call and letting him know?  He's much savvier about this stuff than I am."

"Sure, but I think I spoke to your son the other day when he came to your last appointment, right?"

"No, that's my other son.  It would be great if you could give him a call, too, with the update."

"Okay, so I'll call that son, and I'll also call your other son."

"And my daughter."

"Can one of your sons update your daughter?"

"Well, one son isn't speaking to that daughter. And then I have another daughter who no one is speaking to, but it would be great if you could update her as well."

"I'm happy to talk to your family, but maybe if we could do it all on one conference call, or a family meeting if they're able to come in, or if one of them can be the point person -- it's just hard for me to take the time to call three or four different people with the same news.  I have a lot of patients."

"I was actually also going to ask you to call my brother.  He works in a pharmacy, so he's familiar with a lot of the medical terms."

"Like I said, it would be really great if I could call one person, and then they could tell everyone else the update.  If there's one child or sibling who can be the go-to person that I know to call, that would be the easiest thing."

"Right, except Janet isn't talking to Stu, and Stu isn't talking to Carol, and, really, they're only going to trust what they hear if it comes directly from the doctor. Oh, you need to call my boss, too, so I don't get penalized for taking today off for the appointment."

"I can definitely give you a note."

"No, he's going to think I forged the note, because of something in the past.  It would be much better if you called.  Also I need some refills that I was hoping you could call into the pharmacy."

"Do you have the list of prescriptions you need refills on?"

"I actually left that list with my cardiologist -- he said you could give his office a call and they would let you know."

"He couldn't refill them for you?"

"He said he'd rather leave it to the internist.  I also have an insurance issue -- they said the doctor can call and explain why I needed the scan in March, otherwise they weren't going to cover it."

"Okay, I can call the insurance company...."

"And if you could let my sister know after you've done that -- she's been handling a lot of my paperwork.  That would be great."

"I think I need a list of all of these names and numbers."

"My niece has all of that information.  I can't remember phone numbers anymore, but she said you can give her a call and she'll give you all of those details.  I don't want her knowing the medical stuff, though.  She's just dealing with the phone numbers.  And if you could minimize the test results when you talk to Janet, she's very squeamish with this stuff."

"Like I keep saying, one point person would be great."

"Oh, I almost forgot.  My brother had me take a picture of this mole he's got.  It's on my phone, he asked if I could show you."

"I really can't--"

"I don't need to know what it is, but I told him I'd have you give him a call--"

"I'm not--"

"Oh, also, my step-daughter, Sylvia -- her first language is Spanish.  So if there's some way you could get an interpreter on the phone when you call her.  Different father, she grew up in Mexico--"

"I don't think I can get--"

"Yeah, so I'll have the specialist call you once the results are in, and then you'll update my family?"

"He can--"

"Okay, great, thanks.  I really appreciate it."

Water Pills

"It's pretty hot out, so you should make sure you're drinking enough water."

"I don't like to drink water."

"Well, it's important.  You need to."

"Can't I just take a water pill instead?"

"You mean a diuretic?"

"Sure, whatever."

"I think you're misunderstanding what those kinds of pills do.  They make your body get rid of water.  They're the opposite of what you need when I'm telling you that you might be dehydrated.  You need to drink water."

"I thought those pills were just water in pill form."

"Think about whether that makes sense."

"I don't know.  They make everything into pills these days."

"A pill is not a substitute for drinking water.  Please drink water."

"Can I drink ice water instead?"

"Yes, ice water is fine.  Ice is just water in another form."

"I thought you said water doesn't come in other forms."

"I said it doesn't come in pills.  Ice water is fine."

"The rules are very confusing."

"I'm sorry.  Stay hydrated."

You Can Take My Personal Information And Stick It Where The Sun Don't Shine

"Doc, your 2:30 clinic patient is here...."

"Great, I'll come get him in a second."

"Just one problem."

"Yeah?"

"He won't fill out the forms."

"Can he read?"

"He says he doesn't want to give us his personal information."

"Like, his name and address?"

"Yeah.  And his insurance information.  You can't see him unless we are able to put his information into the system."

"So you want me to talk to him?"

"If you don't mind."

****

"Mr. Jackson, I'm [Anon Doc].  You made a 2:30 appointment?"

"Yeah, I don't feel well."

"The woman at the desk is telling me you won't give her your insurance card."

"I don't want you people knowing all my information."

"We just need the insurance information so that we get paid."

"I don't believe you."

"I don't know what you think we're doing with your insurance information, but if we can't bill your insurance company then we have to bill you directly.  And for that we need your address."

"I'm not giving you that either."

"Then I don't think I'm allowed to see you as a patient here -- you'll have to go to the emergency room and let them take a look."

"The wait's too long."

"I don't have a great solution for you.  What is your medical problem, just so I know?"

"I'm not telling you that either."

"What was your reason for making an appointment?"

"That's none of your business."

"But I'm the doctor.  It's hard to help you if you won't tell me what's wrong."

"Forget it.  I'm leaving."

"Okay, well, if whatever it is gets worse, you should go to the emergency room and they can help you."

"Screw you."

"But I Really Want The Surgery"

"So, I took a look at your blood results, and unfortunately I'm going to need to talk to the surgeon who's planning to perform your procedure next week -- I don't know that it's going to make sense to have the surgery until we figure out why your numbers are so abnormal."

"But I really want the surgery."

"Of course, but it's a non-urgent procedure, and if it has to wait a week or two, just so we make sure it's safe, I think we should do that."

"It's already on my calendar."

"I would think it would be.  Since it's scheduled for next week.  But I don't want you to end up in a situation where the surgery doesn't go well or there's a complication that could have been avoided.  Your platelets are really low, and I'm not sure why."

"But I want the surgery."

"I know.  And I want you to have the surgery.  But I want you to have it safely."

"Why are you telling me I can't get the surgery?"

"I'm trying to explain.  Your lab values were abnormal.  I want to repeat the labs and see if maybe there was an error, or something wrong with the sample.  But if these are the numbers, I think the risks of the surgery outweigh the benefits right now, and I'll want to talk to the surgeon and get his thoughts."

"He knows I want the surgery."

"Sure. But sometimes we need to push things back to be safe."

"Why can't someone else have their surgery pushed back if there isn't room on the schedule?"

"This isn't about the schedule.  I'm trying to explain why you may not be a good candidate for surgery right now, given the blood work.  But let's not get ahead of ourselves.  I'll take some more blood and see what the results show."

"Do you really think you should be taking so much blood from me right before I'm having surgery?"

"Okay, I'm going to have another doctor come in and explain this better."

Poop

"You mentioned fecal incontinence.  Describe what you mean."

"Every time I urinate, I also poop.  Even when I don't feel like I have to go."

"Every time you urinate, you poop?"

"Yes."

"Is it formed, or like diarrhea?"

"What do you mean formed?"

"Is it an actual solid piece of poop, or is it liquid?"

"I think I'd say solid."

"Like, how much are we talking about?"

"Like a small hot dog.  A pig in a blanket, without the blanket."

"Okay...."

"Like the size of a baby corn, I guess."

"Got it."

"Like maybe three jelly beans long."

"Okay, you can stop comparing it to food now."

"It's like the squiggle of toothpaste I put on the toothbrush."

"No more comparisons-- we're good."

"Like a cashew nut."

"Stop."

"Please Fill Your Antibiotic!"

I had a crazy week.  In which I meant to blog but I forgot.  So here I am.  Second-year fellow.  Which feels no different from first-year fellow, except for a tiny salary bump.

A patient comes in with a rash on his chest.  A fairly scary looking rash on his chest.

"How long has it looked like this?"

"Oh, it's definitely worse today than yesterday."

"And yesterday was the first day?"

"No, it's been about a week."

"And you're only coming in to see a doctor now?"

"No, I saw a doctor yesterday."

"Who did you see?"

"I went to the emergency room."

"The emergency room here?"

"No, a different emergency room."

"Which one?"

"I don't remember.  They gave me a prescription for an antibiotic.  They said it should make it better."

"How many doses have you taken."

"None.  I didn't fill the prescription yet."

"Why not?"

"I wanted to see if it would get better."

"You went to the hospital yesterday."

"Yes."

"They gave you an antibiotic and told you to take it."

"Yes."

"You did not take it.  The rash got worse.  You decided to come here and see another doctor."

"Yes."

"Why?"

"Because it did not get better."

"Take the antibiotic!"

"But I want to see if it gets better."

"Take the antibiotic and it will get better!  What did you think I would say?"

"I don't know."

"Take the antibiotic!  Go to the pharmacy.  Fill the prescription.  Take the antibiotic.  Then we'll see if it gets better.  It should get better."

"Maybe I wait one more day?"

"Why?  Take the antibiotic.  Can you not afford to fill the prescription?"

"No, I can."

"So why don't you want to?"

"I don't know."

"Will you promise me you'll fill the prescription and take the antibiotic?"

"Yes."

"Okay.  Feel better.  Goodbye."

Fellow Orientation

The new class of fellows is starting next week, so there are a few days of orientation this week, including a "party" yesterday afternoon in the office for the second-years to meet the new ones.

"Oh, this is nice," one of the new fellows said.  "Are there always snacks like this?"

"No.  Pretty much this is it.  And I think the cookies you're eating are leftover from last year's party."

"Oh."

"Also, I wouldn't actually eat them, because I'm pretty sure the fellow who took them out of the box and put them on this plate came right from clinic, and I didn't see her wash her hands."

"Oh."

"Generally, any food you see in the office has probably been touched by someone who has touched something you wouldn't want to put in your mouth."

"Oh."

"But, you know, I don't want to make you think this isn't a great fellowship."

"I was deciding between doing a fellowship and working at a medical start-up -- a concierge practice, sort of.  They had an on-site gym."

"Yeah, we have the stairs."

"They also catered lunch every day."

"There's a vending machine on the third floor.  It has Swedish Fish."

"But I figured, it was such a limited patient population.  I wanted to see a wider variety of issues, especially at this point in my career."

"Yeah, that's great.  Catered lunch, eh?  They still looking?"

"Ha.  I'm sure this job is a lot more interesting.  And at least you don't get paged in the middle of the night for medication refills."

"I actually just got paged at 3AM for a medication refill."

"Oh."

"The patient thought it was 3PM, not 3AM.  She apologized."

"Oh."

"No, at least she apologized."

"Maybe I'll go meet some of the other fellows."

"Okay."

Is 4 AM the night, or the morning?

I'm on this Sunday, so I tracked down the attending, just to check what time he would be coming in.  The typical thing on weekend shifts is you come in around 8 or 8:30, leisurely round on the patients, and are home by lunchtime.

"Hey, I'm on with you this Sunday.  Just wanted to check the plan."

"Great.  I get in around 4, so if you could pre-round before then, we can quickly go through the patients, and be out of there in a few hours."

"4 in the afternoon?"

"Ha, no."

"Oh.  With other attendings, it's been more like 8 or 9."

"Yeah, I like to have most of my day free.  I guess we can say 4:30, if you really want to sleep in."

"You must be a morning person."

"People tell me that, yeah.  I don't really sleep."

"Okay.  It's not daylight savings time this weekend, or anything like that, is it?"

"I don't think so."

"Okay.  So... 4:30...?"

"Yeah, and if you could pre-round by then, that would be great.  See you on Sunday!"

Oops

When all of your patients are doing okay, there isn't much to write about.  As I see more and more of my outpatients, more and more often, I've been noticing there's a big range of home health aide competence, from the ones who barely know their person's name to the ones who take notes, actually pay attention, and act in a warm, caring way toward the patient.  I think it's a pretty painful job, being a home health aide, especially to a demented person who doesn't have a non-demented spouse involved as well.  It's a lonely job, certainly.  And it's very easy to do it poorly, and hard to do it well.  If you are an aide, and you're bringing your person to the doctor's office, you should probably clean them a little bit first, brush their teeth, put fresh clothes on them -- or you seem like a bad aide.  If you ask questions, especially about medication dosing, you seem like a good aide.  If you wait in the waiting room, and act like the doctor's appointment is your time to make a call on your phone, you seem like a very bad aide.  If you bring a medication list, you seem like a very good aide.

Actually, it doesn't just apply to aides.  If you bring a medication list -- an accurate medication list -- to the doctor visit, you win.  The number of people who don't think that knowing what medicine you're taking is a good idea when you visit a doctor for the first time is really staggering.  If I could pass one health care related edict, I think it would be that people should be mandated to bring medication lists everywhere they go.  And if you've typed up a list of your medical conditions, surgeries, hospitalizations, names and phone numbers of the other doctors you see -- well, I want to give you a lollipop, because you are making your doctor's job a lot easier, and increasing the odds that you get decent medical care.

Also, if you're not the patient -- and you'd be surprised how often this happens -- if you're not the patient, I don't want to take your blood pressure, or weigh you, or answer your own medical questions.  Home health aide, if you need someone to listen to your cough, make an appointment with a doctor for yourself.  Spouse who is not my patient, please don't ask me to check your blood sugar.  And no one is getting a medication refill except the patient I'm actually seeing.  That means your sister, in another state, no -- I'm not calling in her refill, not even if you put her on speakerphone.

Who's On Tonight?

How you know you've been working in the hospital too long:

"Are you going to watch the Tony Awards?"

"I didn't know they were on."

"What are you talking about?  I e-mailed you about them."

"What?  No you didn't."

"Sure I did.  You wrote back and said OK, I didn't know.  But I told you, so now you should know.  Are you OK?"

"Oh."

"What?"

"That explains your e-mail.  I thought you were telling me Tony was on tonight."

"Who's Tony?"

"I figured he was a resident.  I didn't know.  That's why I said I didn't know.  I figured you were telling me Tony was on call tonight.  And that I should know who Tony is.  Even though I don't."

"No.  I was telling you the Tony Awards were on TV.  Do you want to come over and watch them?"

"Not really.  So who's on tonight if not Tony?"

"There is no Tony."

"Oh, yeah."

"I think you should come over."

Wrong Liver

"So, your father is scheduled for surgery tomorrow -- I don't know if the surgeon has been by yet to answer any last-minute questions, but if you have any concerns--"

"I just hope this goes better than last time he had surgery."

"What happened last time?"

"They removed the wrong liver."

"He only has one liver."

"Well now he does -- that's right."

"No, he only started with one liver.  There is only one liver."

"Now, sure.  They didn't even apologize."

"They couldn't have removed the wrong liver.  People have one liver.  And his liver wasn't removed."

"Not the remaining one, no -- I should hope not!"

"He did not have his liver removed."

"Not this one.  The other one."

"He only has one liver."

"Exactly, that's what I'm trying to tell you."

"No, there's something confusing here -- when you're born, you have one liver.  Just one."

"So then you know what he's gone through."

"I'm not talking about me.  I'm talking about everyone.  One liver.  There's no wrong one and right one.  There's just one."

"His was the wrong one."

"Okay, forget it -- that's not even the surgery we're talking about.  You know that he's having surgery on his left hip tomorrow, right?  The surgeon explained it."

"And how many hips will he have afterwards?"

The Diabetic 87-year-old who's 63 and not diabetic.

"Doc, we didn't see you yesterday."

"Yeah, I was off yesterday.  But someone should have stopped by -- there's always a doctor covering."

"Someone did, but we didn't like him."

"Why not?"

"He came in and thought our mother was 87 and diabetic."

"He must have had the wrong chart."

"No, he said that was in the chart.  He showed us."

"She's never been diabetic, right?"

"No."

"That's weird.  I don't know how that happened, but I'll check the chart and fix any mistakes I see."

"Also... you don't think she looks 87, do you?"

"Of course not... but it's hard to judge people's age when they're sick.  Everyone looks older than they really are."

"So how old do you think she looks?"

"That's not a fair question, because I know she's 63."

"But if you didn't know."

"I'd say she looks like an ill 63 year old, unfortunately."

"She used to look 40."

"She used to be 40."

"But you're sure she doesn't look 87."

"Yes."

"Good, because then there's no biological way I could be her son."

The Patient Advocate

Sorry for the gap in posting.  Was on vacation this week, with limited Internet access.  And no pager.  Fortunately.  Back for the holiday weekend.

"I'm told you wanted to transfer your mother?"

"Yeah, we were talking to the patient advocate and she told us we should."

"What?"

"We were telling the patient advocate that we were worried about our mother, and she said there are better hospitals in the area, and we might want to transfer her to one of them."

"The patient advocate said that?"

"Yep."

"Interesting.  So when did you want to transfer her?"

"Now."

"Did you talk to the other hospital about accepting the transfer?"

"No."

"Have you looked into an ambulance to get her there?"

"No."

"Is there a particular doctor you know over there?"

"No.  We were hoping you could take care of all of that for us."

"We can certainly work with the other hospital to arrange the transfer, but you need to contact a doctor over there and start the process."

"Do you have the phone number of a good doctor there, who would be better than you at treating her?"

"Honestly, I don't know anyone over there."

"I guess we can just ask the patient advocate."

"Okay."

The Physical Therapist Is A Fictional Character

A family asks to talk to a doctor.  I'm just a consultant on the patient, but I'm there, so I'm the one they get.

"Doc, we're frustrated because he's been here a week and still hasn't seen physical therapy."

"I do see that the order was put in five days ago.  I can put in a call to physical therapy and see why they haven't come yet, but I'm not sure what else I can do about that."

"That's not an answer."

"No, it's not, but let me give them a call and see if I can get them to come sooner than they might otherwise."

"It's been a week."

"I understand."

"Is there actually physical therapy, or is it just a lie you tell people, so we stop asking about it?"

"There is actually physical therapy.  I've met some of the physical therapists.  They are actual people."

"Hard to believe that."

"I understand that you're frustrated."

"When we asked the nurse, she said she'd never seen physical therapy come see a patient."

"I have to imagine she was joking."

"She didn't seem like she was joking."

"Then maybe someone misunderstood.  I don't know why physical therapy hasn't come yet.  I assume they're very busy.  But I don't know.  I will call them."

"You'd better do more than call them."

"I will talk to the physical therapy director."

"While you're at it, can you talk to the director of nursing and get us a new nurse?"

"I don't know that I can get you a new nurse.  If you're having a problem with your nurse, you can ask to speak to the nurse manager."

"More people to speak to?  This is ridiculous.  I want to speak to another doctor."

"I can have another doctor speak to you.  I'm not the primary doctor for your father, but I am familiar with his case.  That's why they had me talk to you.  I know you're frustrated.  You have a right to be frustrated.  Do you have any medical questions?"

"Yes.  Why does he need physical therapy when he's walking fine?"

"I thought you were upset he wasn't getting physical therapy."

"No, I'm upset that we were told we're entitled to physical therapy, and we're not getting it.  This is a different question, about why he would need physical therapy."

"Perhaps he doesn't, and that's why physical therapy hasn't come."

"If we're entitled to physical therapy, we want physical therapy.  If it's part of the package, we definitely want it."

"There's not a package.  Your father is supposed to get the treatment he needs."

"We also need some more of those toothbrushes that were in his room."

"You can ask the nurse for toothbrushes."

"We don't like the nurse."

"I don't have any toothbrushes."

"When is physical therapy coming?"

"I'm going to have you talk to a different doctor."

"I'd like to speak to the [p]resident"

I'm on call in the hospital and I get paged that a patient's family wants to talk to me about a patient I consulted on earlier.  I stop by the room.

"Are you the president?"

"Pardon?"

"Are you the president of the hospital?"

"No.  I'm the fellow who saw your mother earlier today."

"My wife has a brother who is a doctor, and he told me I should always make sure I speak to the president, because the president will be most familiar with the patient."

"I think you probably misheard.  He probably said resident."

"No, he said president."

"I think he said resident."

"Why would I want a resident of the hospital to know about my mother's condition?"

"Residents are the doctors who are most involved with the medical plan.  I was a resident until last year, and now I am a fellow.  The attendings are the doctors in charge of the decision-making.  That's just the hierarchy of the team.  The hospital president is not involved in patient care."

"He should be.  I want to speak to him, like my wife's brother said."

"I'm sure he said resident.  I can get the resident to stop by after rounds."

"The young woman we spoke to before?"

"Probably."

"She didn't seem like she was the president of anything."

"She wasn't the president, she was the resident."

"I'd rather wait for the president."

I Have Most of My Parts

96-year-old patient.  Female.  Complaining of stomach pain.

"I'm just going to see if there's any tenderness, okay?"

"I didn't know you were going to be touching me."

"I'm sorry, is that okay?"

"Yes, but I would have put on a little more makeup."

"Let me know if you feel anything."

"Oooh.  Yes, that hurts."

"And how about here?"

"Yes, that hurts too."

"I didn't see anything in your chart... have you had any surgeries in that area?"

"Surgery?  Like what?"

"Have you ever had any ovarian issues, have you had a hysterectomy, anything like that?"

"Well, I don't get my period anymore."

"No, I wouldn't expect that you would."

"And the doctor said I can't have any more children."

"Right, but is that because of any procedure you may have had, even if it was years and years ago?"

"Now that you mention it, I think they did take something out."

"Do you know what they took out?  Did you have a hysterectomy?"

"To be honest, I don't know.  I'm not really sure what's inside me anymore."

"Okay, I'm going to send you for a scan to see what's inside of you, and to make sure there's nothing concerning going on.  Obviously we don't want to look for problems at your age that it's better not to find, but I just want to see if we can figure out if there's a reason why you're so tender down there."

"You don't think that doctor was wrong and I'm pregnant."

"No, I don't."

"Okay, that's a relief."

Yes, I know that word.

"Doctor, I've been having terrible itching."

"Where is the itching?"

"My anus."

"Okay, how long has this been going on?"

"A while.  There is also some leakage."

"Oh."

"Yes, s*** is coming out.  I know that's not a medical word.  Do you know that word?"

"Yes."

"So you know what I mean when I say s*** is coming out of my anus?"

"Yes, I know what you mean."

"Because I don't know the medical word, but I wasn't sure if you would understand what I mean by s***."

"I understand what you are saying."

"Yes, it is leaking out of my anus."

"Okay."

"The s***."

"I got it.  I can give you a cream."

"To put in my anus?"

"To put on the skin, for the itching.  And I'm going to refer you to a gastroenterologist for the leakage.  I hope you feel better."

"I just feel like I'm always covered in s***."

"I'm sorry."

"You know what I'm talking about, right?  Even though that's not the medical word."

"Yes."

"Okay, I just wanted to make sure."

"Take care."

Opening Questions To Bad Conversations

"Do you know where the morgue is?"

"Wait, how many pills did you give him?"

"Does the patient have any family you think might be likely to sue?"

"Oh, so this was the patient you were talking about?"

"Did it always look like that?"

"Was there a patient in here earlier?"

"Do you know if she's an organ donor?"

"Is there a way we could get that cleaned up before it causes any more problems?"

"Has it smelled this bad for a while?"

"I'm sorry, your fever was what?"

"Did you see if the teeth are in the closet?"

"You don't happen to know if your father had any undocumented allergies, do you?"

"So no one had checked his pressure since... Tuesday?"

"Your malpractice insurance is all paid up, right?"

"Are you sure that was a doctor who works here?"

"Did you mark the leg that was supposed to be cut, or the one that wasn't?"

"Are you sure it always looked like that?"

"You went to the bathroom how many times?"

"You haven't gone to the bathroom in how many days?"

"Wait, can you say that again, but trying not to slur your words?"

"Is she always this difficult to rouse?"

"Did you ever follow up on that?"

"Did you notice that last time you saw her?"

"Do you think the med school would even want a body in this condition?"

"Do we have beds that can support that much weight?"

"Did I just step in what I think I stepped in?"

"Did all of that actually come out of your body?"

"Does anyone know where the crash cart disappeared to?"

"Oh, was I supposed to be running this code?"

Seeing Patients Is For Losers

"So, have you thought about what you want to do after fellowship?"

"Of course it depends on the jobs that are out there... but I think I want to find something that's mostly outpatient."

"Like, private practice?"

"Yeah, maybe."

"Ugh.  So you just want be a... clinician?"

"I find it more satisfying than inpatient-- you get to form actual relationships with your patients when they're not acutely ill...."

"No research?"

"I'm not opposed to research.  I just don't know that I'm passionate about it."

"So you really just want to see patients... in an office...?  That's so, I don't know... unambitious.  That's really why you went to medical school?"

"I guess so, yeah."

"Ugh.  Seeing patients is so annoying.  I can't believe that's really what you want to waste your time doing."

"I don't think it's so completely a waste."

"You know what I mean."

"Sort of."

"Well, whatever, I guess if I hear of anything ridiculous like that, anyone looking, I'll send you an e-mail."

"Thanks."

"You do realize we're probably hiring a whole bunch of people to do inpatient hospitalist stuff, right?  Mixed with research and some teaching?"

"Yeah, I heard about that."

"And you'd rather see patients."

"I think so, yeah."

"Whatever, it's your life."